The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®

Abstract

CMS uses Adult HCAHPS® scores for public reporting and pay-for-performance for most U.S. hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS/AHRQ commissioned the development of the Consumer Assessment of Healthcare Providers and Systems Hospital Survey – Child Version (Child HCAHPS), a survey of parents/guardians of pediatric patients (<18 years old) who were recently hospitalized. This Special Article describes the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and to develop composite measures. We analyzed national field test data from 17,727 surveys collected from 11/12-1/14 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.

Parent-Reported Errors and Adverse Events in Hospitalized Children

“…One approach is to instruct all parents on how to report potential errors; the inclusion of an item asking parents whether they were informed of the hospital's error-reporting process in the Child Hospital Consumer Assessment of Healthcare Providers and Systems survey 30 may prompt more hospitals to systematically provide such information to all families. By priming parents to pay attention to safety, hospitals may be able to engage them to help identify errors and perhaps even mitigate those that are potentially harmful.…”

Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS

“…25 The final Child HCAHPS Survey instrument has 62 items, including 39 patient experience items (which comprise 18 composite and single-item measures), 10 screening questions, 12 demographic/descriptive items, and 1 open-ended item. We found that hospital-level reliability for our composite and single-item measures would be good to excellent at the recommended sample size of 300, comparable to Adult HCAHPS 26 and reaching recommended levels for comparison.…”

“…During the development of the Child HCAHPS Survey, we tested the effects of variables available from the survey and hospitals’ administrative data and identified those that were predictive of responses and also had unequal distributions at different hospitals. 25, 28 In our final model, child covariates are age (<1, 1–4, 5–8, 9–12, ≥13 years) and parent-reported global health status (excellent, very good, good, fair, poor). Parent covariates include age (<25, 25–34, 35–44, ≥45 years); relationship to child (mother, father, other); education (≤8th grade, some high school, high school diploma or general educational development, some college or 2-year degree, 4-year college degree, >4-year college degree); and preferred language (English, Spanish, other).…”

Patient and Family Experience in the Healthcare Value Equation

“…This tool is used by most major children's hospitals and, like Adult HCAHPS, focuses on aspects of inpatient care that are important for patients and their parents. The pediatric survey contains 62 items that assess the following themes: communication with parents, communication with children, attention to safety and comfort, hospital environment, and global rating [43]. Information is obtained from parents, who act as a proxy for their child in answering questions.…”